title: Geographic access to health services and diagnosis with an autism spectrum disorder.
abstract: OBJECTIVE
  To assess the impact of geographic health services factors on the timely diagnosis of autism.
  
  
  METHODS
  Children residing in central North Carolina were identified by records-based surveillance as meeting a standardized case definition for autism. Individual-level geographic access to health services was measured by the density of providers likely to diagnose autism, distance to early intervention service agencies and medical schools, and residence within a Health Professional Shortage Area. We compared the presence of an autism diagnosis by age 8 and timing of first diagnosis across level of accessibility, using Poisson regression and Cox proportional hazards regression and adjusting for family and neighborhood characteristics.
  
  
  RESULTS
  Of 206 identified cases, 23% had no previous documented diagnosis of autism. Most adjusted estimates had confidence limits including the null. Point estimates across analyses suggested that younger age at diagnosis was found for areas with many neurologists and psychiatrists and proximal to a medical school but not areas with many primary care physicians or proximal to early intervention services agencies.
  
  
  CONCLUSIONS
  Further study of the distribution of medical specialists diagnosing autism may suggest interventions to promote the early diagnosis, and initiation of targeted services, for children with autism spectrum disorders.
authors.affiliation: Department of Epidemiology, University of North Carolina at Chapel Hill, Gillings School of Global Public Health, Chapel Hill, NC 27599, USA. amyk@unc.edu
authors.forename: Amy E
authors.initials: AE
authors.lastname: Kalkbrenner
authors.forename: Julie L
authors.initials: JL
authors.lastname: Daniels
authors.forename: Michael
authors.initials: M
authors.lastname: Emch
authors.forename: Joseph
authors.initials: J
authors.lastname: Morrissey
authors.forename: Charles
authors.initials: C
authors.lastname: Poole
authors.forename: Jiu-Chiuan
authors.initials: JC
authors.lastname: Chen
mesh_terms: D002648:Child; D002659:Child Development Disorders, Pervasive / Q000175:diagnosis*; D015331:Cohort Studies; D042241:Early Diagnosis; D005260:Female; D006297:Health Services Accessibility; D006801:Humans; D008297:Male; D009657:North Carolina; D011159:Population Surveillance